Bao Changqian, Tao Xiandong, Cui Wei, Yi Bin, Pan Tiewen, Young Ken H, Qian Wenbin
Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009 China.
Program in Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, 310058 China.
Exp Hematol Oncol. 2020 Jul 17;9:16. doi: 10.1186/s40164-020-00172-4. eCollection 2020.
Coronavirus disease 2019 (COVID-19) is a novel infectious viral disease, which lacks well-established diagnostic laboratory parameters that could be used to evaluate disease severity, thromboembolism or cardiovascular events and to predict clinical prognosis. Coagulation cascade and platelet functions have not been well studied in the COVID-19 patients.
A total of 178 patients enrolled in Wuhan Huoshenshan Hospital were included for the study. Blood platelets and coagulation functions were analyzed in COVID-19 patients with non-severe and severe subgroups. Other biochemical laboratory parameters were also analyzed.
Forty-nine (27.5%) out of 178 patients were diagnosed with severe disease in this study, and 129 patients with non-severe disease. Severe disease group had significant lower platelet count 186.00 (103.50-249.00) ×10/L than 251.00 (202.00-317.00) ×10/L of non-severe group, = 0.000. Severe group also had significantly abnormal coagulation parameters than non-severe group: prothrombin time (PT) 14.55 (13.40-16.53) s vs. 12.70 (12.15-13.59) s, = 0.000; international normalized ratio (INR) 1.21 (1.13-1.36) vs. 1.06 (1.01-1.13), = 0.000; thrombin time (TT) 16.35 (15.69-17.47) s vs. 15.68 (14.79-16.69) s, = 0.011; D-Dimer 1.05 (0.68-5.90) mg/L vs. 0.42 (0.28-0.79) mg/L, = 0.000; While the liver function parameter alanine aminotransferase (ALT) and aspartate aminotransferase (AST) didn't show significance between two groups, ALT 30.80 (19.00-58.30) IU/L vs. 28.80 (15.75-50.15) IU/L, = 0.487; AST 27.80 (19.30-40.55) IU/L vs. 22.6 (16.7-32.03) IU/L, = 0.102. Disseminated intravascular coagulation (DIC) rate was 6.1% in severe group while 0% in non-severe group. Survival rate of severe disease group was worse than non-severe group, 85.7% vs. 100%, = 0.000. Thrombocytopenia correlated with coagulation function, DIC rate and survival. Six out of 7 death case had thrombocytopenia during hospitalization, and platelet count decreased subsequently until death. Thrombocytopenia occurred within 1 week after admission in 6 recovered patients. And increased platelet levels followed by positive SARS-CoV-2 IgM/IgG and negative coronavirus nucleic acid tested in 8 recovered patients.
Low platelet count is associated with abnormal coagulation function and increased risk of DIC, severe disease manifestation and increased mortality in patients with COVID-19.
2019冠状病毒病（COVID-19）是一种新型传染性病毒性疾病，缺乏成熟的诊断实验室参数，无法用于评估疾病严重程度、血栓栓塞或心血管事件以及预测临床预后。COVID-19患者的凝血级联反应和血小板功能尚未得到充分研究。
本研究纳入了武汉火神山医院收治的178例患者。对COVID-19患者的非重症和重症亚组进行血小板和凝血功能分析。还分析了其他生化实验室参数。
本研究中，178例患者中有49例（27.5%）被诊断为重症，129例为非重症。重症组血小板计数显著低于非重症组，分别为186.00（103.50 - 249.00）×10⁹/L和251.00（202.00 - 317.00）×10⁹/L，P = 0.000。重症组的凝血参数也显著异常于非重症组：凝血酶原时间（PT）分别为14.55（13.40 - 16.53）秒和12.70（12.15 - 13.59）秒，P = 0.000；国际标准化比值（INR）分别为1.21（1.13 - 1.36）和1.06（1.01 - 1.13），P = 0.000；凝血酶时间（TT）分别为16.35（15.69 - 17.47）秒和15.68（14.79 - 16.69）秒，P = 0.011；D - 二聚体分别为1.05（0.68 - 5.90）mg/L和0.42（0.28 - 0.79）mg/L，P = 0.000；而肝功能参数谷丙转氨酶（ALT）和谷草转氨酶（AST）在两组间无显著差异，ALT分别为30.80（19.00 - 58.30）IU/L和28.80（15.75 - 50.15）IU/L，P = 0.487；AST分别为27.80（19.30 - 40.55）IU/L和22.6（16.7 - 32.03）IU/L，P = 0.102。重症组弥散性血管内凝血（DIC）发生率为6.1%，非重症组为0%。重症组生存率低于非重症组，分别为85.7%和100%，P = 0.000。血小板减少与凝血功能、DIC发生率和生存率相关。7例死亡病例中有6例在住院期间出现血小板减少，随后血小板计数持续下降直至死亡。6例康复患者在入院后1周内出现血小板减少。8例康复患者血小板水平升高，随后SARS-CoV-2 IgM/IgG呈阳性，冠状病毒核酸检测呈阴性。
血小板计数低与COVID-19患者的凝血功能异常、DIC风险增加、重症表现及死亡率增加相关。
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